CRCR Study Guide 2023 with complete solution
Patient Centric Revenue Cycle
This includes all the major processing steps required to process a pt account from the
request for service through closing the account with a zero balance and purging it from
the system
pre-service
this is the period in which scheduling and pre-access takes place, including different
steps that will be completed
pre-service
what is it when the requested service is screened for medical necessity, health plan
coverage & benefits are verified, and pre-auth is obtained
scheduled patient- Time of Service
what is it when a final account review is completed prior to the patient's arrival? (Pre-reg
record is activated, consents are signed, and co-payments and other amounts are
collected)
express arrival
pre-processed patient's can report to this, which is a desk located in a centralized
access, upon their arrival.
post-service
this includes account activities that occur after the patient is d/c until the account
reaches a zero balance
post-service
Final coding of all services, perparation and submission of claims, payment processing
and balance billing are all included and finalized when?
Patient Financial Communications Best Practices
This brings consistency, clarity, and transparency to patient financial communications
Patient Financial Communications Best Practices
this outlines steps to help patient's understand the cost of services they receive, their
insurance coverage, and their individual responsibility (review Patient Financial Comm.
Best Practice document)
true
true or false: Conversations should occur in a location and manner that are sensitive to
the patient's needs
timely discussions
this type of discussion will help ensure that patient's understand their financial obligation
and that providers are aware of the patient's ability to pay
guarantor
the person responsible for payment of the bill
true
true or false: A financial counselor or supervisor should be involved for complex
situations such as uninsured or underinsured patient's
false; NO patient financial discussions should occur before a patient is screened
and stabilized
true or false: You MUST obtain basic registration info and insurance coverage before
the patient is cared for in the ED.
, true
true or false: When the provider takes the initiative to communicate financial matters
with the patient, it actually take a burden off the patient.
false; Technology evaluation may be performed by ANY qualified individual or
organization, internal or external
true or false: Technology evaluation can ONLY be done by a qualified individual,
internal to the facililty
HFMA's Adopter Program
this program is a recognition for providers who implement and support the best
practices are eligible and encouraged to apply
Code of Conduct
Through what document does a hospital est. compliance standards?
Identify acceptable compliance programs in various provider setting
what is the purpose OIG work plan?
non-diagnostic services provided on Tuesday through Friday
If a Medicare pt is admitted on Friday, what services fall within the 3-day DRG window
rule?
reports a specific circumstance that affects a procedure or service without
changing the code or its definition.
What does a modifier allow a provider to do?
they must be billed separately to the Part B carrier
if OP diagnostic services are provided within 3 day of admission of a medicare
beneficiary to an IPPS (Inpatient Prospective Payment system) hospital, what must
happen?
One registration record is created for multiple days of service
What is recurring or series registration?
unscheduled patients
what are non-emergency pt who come for service w/o prior notification to the provider
called?
used to evaluate the need for an IP admission
Which of the following statements apply to the Obs patient type?
physician, nursing, and pharmacy
which services are hospice programs required to provide on a around-the-clock patient?
q
complete the scheduling process correctly based on service requested
Scheduler instructions are used to prompt the scheduler to do what?
procedure time
This is the time needed to prepare the patient before services is the difference between
the patients arrival time?
Documentation of the medical necessity for the test
Medicare guidelines require that when a test is ordered for which an LCD (local cover
determination) or NCD (national coverage determination) exists, the info on the order
must include what?
it reduces processing times at the time of service
what is an advantage of a pre-registration program?
the responsible party's full legal name, DOB, and SSN
Patient Centric Revenue Cycle
This includes all the major processing steps required to process a pt account from the
request for service through closing the account with a zero balance and purging it from
the system
pre-service
this is the period in which scheduling and pre-access takes place, including different
steps that will be completed
pre-service
what is it when the requested service is screened for medical necessity, health plan
coverage & benefits are verified, and pre-auth is obtained
scheduled patient- Time of Service
what is it when a final account review is completed prior to the patient's arrival? (Pre-reg
record is activated, consents are signed, and co-payments and other amounts are
collected)
express arrival
pre-processed patient's can report to this, which is a desk located in a centralized
access, upon their arrival.
post-service
this includes account activities that occur after the patient is d/c until the account
reaches a zero balance
post-service
Final coding of all services, perparation and submission of claims, payment processing
and balance billing are all included and finalized when?
Patient Financial Communications Best Practices
This brings consistency, clarity, and transparency to patient financial communications
Patient Financial Communications Best Practices
this outlines steps to help patient's understand the cost of services they receive, their
insurance coverage, and their individual responsibility (review Patient Financial Comm.
Best Practice document)
true
true or false: Conversations should occur in a location and manner that are sensitive to
the patient's needs
timely discussions
this type of discussion will help ensure that patient's understand their financial obligation
and that providers are aware of the patient's ability to pay
guarantor
the person responsible for payment of the bill
true
true or false: A financial counselor or supervisor should be involved for complex
situations such as uninsured or underinsured patient's
false; NO patient financial discussions should occur before a patient is screened
and stabilized
true or false: You MUST obtain basic registration info and insurance coverage before
the patient is cared for in the ED.
, true
true or false: When the provider takes the initiative to communicate financial matters
with the patient, it actually take a burden off the patient.
false; Technology evaluation may be performed by ANY qualified individual or
organization, internal or external
true or false: Technology evaluation can ONLY be done by a qualified individual,
internal to the facililty
HFMA's Adopter Program
this program is a recognition for providers who implement and support the best
practices are eligible and encouraged to apply
Code of Conduct
Through what document does a hospital est. compliance standards?
Identify acceptable compliance programs in various provider setting
what is the purpose OIG work plan?
non-diagnostic services provided on Tuesday through Friday
If a Medicare pt is admitted on Friday, what services fall within the 3-day DRG window
rule?
reports a specific circumstance that affects a procedure or service without
changing the code or its definition.
What does a modifier allow a provider to do?
they must be billed separately to the Part B carrier
if OP diagnostic services are provided within 3 day of admission of a medicare
beneficiary to an IPPS (Inpatient Prospective Payment system) hospital, what must
happen?
One registration record is created for multiple days of service
What is recurring or series registration?
unscheduled patients
what are non-emergency pt who come for service w/o prior notification to the provider
called?
used to evaluate the need for an IP admission
Which of the following statements apply to the Obs patient type?
physician, nursing, and pharmacy
which services are hospice programs required to provide on a around-the-clock patient?
q
complete the scheduling process correctly based on service requested
Scheduler instructions are used to prompt the scheduler to do what?
procedure time
This is the time needed to prepare the patient before services is the difference between
the patients arrival time?
Documentation of the medical necessity for the test
Medicare guidelines require that when a test is ordered for which an LCD (local cover
determination) or NCD (national coverage determination) exists, the info on the order
must include what?
it reduces processing times at the time of service
what is an advantage of a pre-registration program?
the responsible party's full legal name, DOB, and SSN
